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12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character
Initial Affiliation Date
Affiliate Status
AccountId
PrimaryContactId
Docs are Current
TRUE
Dues Waived
TRUE
Affiliate Profile
Please verify and update the information below as necessary.
Fields marked with an "*" are mandatory.
Official Name of Affiliate
255 characters left.
Year Established
Street Address
City
State
2 characters left.
Zip Code
10 characters left.
Phone
Number of Locations/Offices
7 characters left.
Please upload** a list of locations with address and phone number
**Note: there is a 35 MB limit for the total size of uploaded files submitted on this form. If an error is received after submitting this form, please reduce the size of the total documents uploaded to under 35 MB and submit again.
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Organization Information
Number of full-time staff
6 characters left.
Number of part-time staff
6 characters left.
States/Counties Served
3000 characters left.
Unduplicated count of persons (participant/clients/customers) served last year
7 characters left.
Enter the % of persons served last year for each demographic (totaling 100%)
Hispanic, Latino or Spanish Origin
2 characters left.
White
2 characters left.
Black or African American
2 characters left.
American Indian or Alaska Native
2 characters left.
Asian
2 characters left.
Native Hawaiian or Pacific Islander
2 characters left.
Two or More Races
2 characters left.
Organizational Budget
$0 - $100,000
$100,001 - $500,000
$500,001 - $1,000,000
$1,000,001 - $5,000,000
$5,000,001 - $10,000,000
$10,000,001+
Membership amount due
Based on organizational budget
Do you need an invoice?
Yes
No
Please upload** the last audited financial statements of all public and private funds received, or the last Form 990 submitted to the IRS
**Note: there is a 35 MB limit for the total size of uploaded files submitted on this form. If an error is received after submitting this form, please reduce the size of the total documents uploaded to under 35 MB and submit again.
Add Another Financial File
Please upload** a list of the Board of Directors and Senior Management
**Note: there is a 35 MB limit for the total size of uploaded files submitted on this form. If an error is received after submitting this form, please reduce the size of the total documents uploaded to under 35 MB and submit again.
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Programs Offered
If your Organization offers multiple Programs, click the "Add Another Program" button for each additional Program
ProgramId
Program Name
80 characters left.
Target Population
2000 characters left.
Program Funding Source
255 characters left.
Funding Amount
18 characters left.
Program Status
Active
Planned
Completed
Cancelled
Primary Program Category
Advocacy
Counseling
Education
Emergency Assistance
Employment
Financial Stability
Food and Nutrition
Housing
Information & Referral
Legal
Medical Health
Mental Health
Seasonal Programs
Workforce Development
My program covers a secondary category
Yes
No
Secondary Program Category
Advocacy
Counseling
Education
Emergency Assistance
Employment
Financial Stability
Food and Nutrition
Housing
Information & Referral
Legal
Medical Health
Mental Health
Seasonal Programs
Workforce Development
Please add one or two sentences describing your program
32000 characters left.
Add Another Program
Form Submitted By
First Name
Last Name
Title
128 characters left.
Phone
Email
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